Comparison of Safety and Efficacy of Diazepam and Midazolam for Moderate Sedation during Gastric Endoscopic Submucosal Dissection.

IF 2 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY
Jun Takada, Takuji Iwashita, Kiichi Otani, Naoya Masuda, Hiroki Taniguchi, Yukari Tezuka, Masamichi Arao, Kentaro Kojima, Sachiyo Onishi, Masaya Kubota, Takashi Ibuka, Masahito Shimizu
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引用次数: 0

Abstract

Introduction: The appropriate use of benzodiazepines for sedation during prolonged therapeutic endoscopy has not yet been established. This retrospective observational study compared the safety and efficacy of diazepam (DZP) and midazolam (MDZ) under moderate sedation during gastric endoscopic submucosal dissection (ESD).

Methods: We studied 554 patients who underwent gastric ESD under sedation with DZP or MDZ combined with pentazocine. Sedation depth was assessed and recorded using the Richmond Agitation-Sedation Scale (RASS). According to the American Society of Anesthesiologists definition of sedation levels, RASS scores of -4 to -2 points indicated moderate sedation, whereas a score of -5 points indicated deep sedation. Sedation levels, respiratory and circulatory dynamics during the procedure, and the incidence of ESD-related pneumonia were compared.

Results: Of these, 273 and 281 patients received DZP and MDZ, respectively. No significant differences were observed in the occurrence of deep sedation (DZP:MDZ = 12.1%:15.4%) or in the proportion of patients who maintained moderate intraoperative sedation (76.2%:80.4%). Respiratory parameters showed no significant differences; however, blood pressure reduction was more common in the MDZ group (4.8%:11.0%, p = 0.007). Multivariate analysis identified MDZ as a significant factor associated with blood pressure reduction. The incidence of ESD-related pneumonia did not differ between the two groups.

Conclusions: DZP and MDZ were similarly effective in maintaining adequate sedation levels during gastric ESD. Respiratory depression did not differ between the groups; however, circulatory depression was more pronounced in the MDZ group.

地西泮与咪达唑仑用于胃内镜下粘膜剥离术中适度镇静的安全性和有效性比较。
在长时间的治疗性内窥镜检查中,苯二氮卓类药物用于镇静的适当使用尚未确定。本回顾性观察性研究比较了地西泮(DZP)和咪达唑仑(MDZ)在胃内镜下粘膜下剥离(ESD)中适度镇静的安全性和有效性。方法:对554例经DZP或MDZ联合戊唑嗪镇静后发生胃ESD的患者进行研究。采用Richmond激动-镇静量表(RASS)评估和记录镇静深度。根据美国麻醉医师协会对镇静水平的定义,RASS评分为4到2分表示中度镇静,而评分为5分表示深度镇静。比较镇静水平、手术过程中的呼吸和循环动力学以及esd相关肺炎的发生率。结果:其中接受DZP和MDZ治疗的患者分别为273例和281例。深度镇静发生率(DZP:MDZ = 12.1%:15.4%)和术中保持中度镇静的患者比例(76.2%:80.4%)差异无统计学意义。呼吸参数差异无统计学意义;然而,血压下降在MDZ组更为常见(4.8%:11.0%,p=0.007)。多变量分析确定MDZ是与血压降低相关的重要因素。两组间静电放电相关肺炎的发生率无差异。结论:DZP和MDZ在胃ESD中维持足够的镇静水平同样有效。两组间呼吸抑制无显著差异;然而,循环抑制在MDZ组更为明显。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Digestive Diseases
Digestive Diseases 医学-胃肠肝病学
CiteScore
4.80
自引率
0.00%
发文量
58
审稿时长
2 months
期刊介绍: Each issue of this journal is dedicated to a special topic of current interest, covering both clinical and basic science topics in gastrointestinal function and disorders. The contents of each issue are comprehensive and reflect the state of the art, featuring editorials, reviews, mini reviews and original papers. These individual contributions encompass a variety of disciplines including all fields of gastroenterology. ''Digestive Diseases'' bridges the communication gap between advances made in the academic setting and their application in patient care. The journal is a valuable service for clinicians, specialists and physicians-in-training.
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